Carnage Tender Loving Care Adc

NPI 1104177567 - Clinic/Center - 261QA0600X

NPI Details
NPI 1104177567
Enumeration Date 09/26/2012
Last Updated 09/26/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name AUGUSTA AUGUSTA
Position OWNER
Phone (662) 254-0011
Fax (662) 254-9511
Practice Location
102 WHEELER ST
ITTA BENA MS, 38941-1919, US
Phone (662) 254-0011
Fax (662) 254-9511
Business Location
PO BOX 474
ITTA BENA MS, 38941-0474, US
Phone (662) 254-0011
Fax (662) 254-9511
Toxanomy
Taxonomy Code 261QA0600X
License State
License Number
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According to our database, Carnage Tender Loving Care Adc NPI is 1104177567, taxonomy code is 261QA0600X Carnage Tender Loving Care Adc physically located at 102 Wheeler St, Itta Bena MS, 38941-1919. NPI Number 1033115704 has the healthcare provider type.

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1104177567 NPI number is provided on an as is basis without warranty of any kind. 1104177567 is maintained by the National Plan & Provider Enumeration System. The contents of Carnage Tender Loving Care Adc are for informational purposes only.